Provider Demographics
NPI:1275794240
Name:MCINTOSH, SHANNON ELAINE (PHARMD)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:ELAINE
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:ELAINE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:577 MID RIVERS MALL DR
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-2113
Mailing Address - Country:US
Mailing Address - Phone:636-970-2858
Mailing Address - Fax:636-970-0023
Practice Address - Street 1:577 MID RIVERS MALL DR
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376
Practice Address - Country:US
Practice Address - Phone:636-970-2858
Practice Address - Fax:636-970-0023
Is Sole Proprietor?:No
Enumeration Date:2008-06-22
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007022166183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist